Skewed Vaccine Distribution May Be Illegal – VG

– If we distribute the bias based on residential address, it means that we will discriminate with regard to healthcare, and we really need to look at that, says director of infection control Geir Bukholm at FHI to VG.

He says lawyers for the Norwegian Health Directorate will now find out whether it is legal for the state to unevenly distribute access to health care in Norway due to the residential address of residents.

They will propose a clarification on Friday, says Bukholm.

– Could it be illegal?

– Yes, there is an opportunity for that. What they have to do with is the legislation that evaluates any type of medical care, such as the Law on Patient Rights and the Law on Specialized Health Services.

– So it is the provision of the Infection Control Law that can triumph over other legislation in a crisis situation, he says.

This is the dilemma

Health Minister Bent Høie (H) said at Tuesday’s press conference that the Norwegian Health Directorate and FHI have been tasked with quickly clarifying some legal and ethical issues raised by FHI. This legal issue is highlighted in the FHI report, which laid the foundation for the government’s decision to unevenly distribute to districts of Oslo and some other municipalities with persistently high infection pressure.

The seas: These municipalities must give away doses of vaccines

The dilemma is this: if you skew a certain proportion of the vaccine doses to some areas, it means that other areas receive a corresponding proportion of fewer doses.

This means that the state decides that some people in Norway then receive the necessary medical care at the expense of people with a lower personal risk profile, but a higher probability of infection in other regions, who receive medical care.

If you are 70 years old with various underlying diseases, but live in a municipality with low infection pressure, you may end up further back in the vaccine queue than a 55-year-old man in Oslo.

The government follows the FHI recommendation of a modest and skewed distribution, which means that municipalities with high infection pressure and many admissions over time receive 20% more vaccines. The doses are obtained from 330 municipalities that have had four or less admissions in the last six months, which can receive three percent fewer doses of vaccine. See which ones here.

Guldvog: Districts will lose

At the same time, this means that the effect of the strategy will depend on whether assumptions are made about the development of the pandemic in the future. Director Bjørn Guldvog of the Norwegian Health Directorate acknowledges that such a skewed distribution is still problematic.

– The starting point is how the situation has been and there is uncertainty about how it will be in the future. There is a certain chance that he is wrong and that the pressure of the infection is just as great elsewhere, he tells VG.

– Are districts losing this solution?

– They will, since you take away their vaccines and prioritize individual municipalities.

– And with this greater risk to life and health?

– These are theoretical models in which our goal is to have as low an infection as possible, in order to obtain as few deaths as possible overall. There will be no profit in both places: if we redistribute, there will be one place that turns out worse and another that turns out better.

NIPH Director Camilla Stoltenberg believes the toughest dilemmas are related to the risk of losing rather than winning. That is why their recommendation was based on the modest distribution. In this proposal, very little is lost in the municipalities that give away doses, explains Stoltenberg.

– In the proposal that we have recommended, there is very little to lose in the municipalities that give away doses. The distribution by persistent infection pressure occurs at the same time as a significant increase in access to doses and a change in the key distribution by population that will contribute to a distribution different from the one we have today. Both to some of the municipalities that have had high contagion pressure for a long time, as well as to many others.

FHI has calculated that skewed distribution of vaccine doses will result in increased health benefits in the form of a reduction in hospitalizations, deaths, and infections nationwide.

Legal Expert: Legal

Health law expert Anne Kjersti Befring from the University of Oslo tells VG that she cannot see how this uneven distribution can be illegal.

– This has different aspects: you have the right to a vaccine, that is, the right to be protected against serious illness and death. But here, too, you have to consider whether the vaccine is likely to protect against the spread of infection, he says.

– Some will be much more likely to die than others, but being prone to death is not just about age and underlying diseases. It also has to do with the risk of infection. And where we have large groups of infection, there is also a higher risk of becoming infected and dying. It’s usually where people are crowded together, says Befring.

She says that a skewed distribution may be precisely safeguarding equality, if health authorities can document that it helps spread the infection and therefore protects more people.

– There is a constitutional prohibition against unreasonable discrimination. It is also established in the Law of Patient and User Rights: You must not have unreasonable discrimination, that is, make a difference without having a valid reason. But do you have a factual reason, for example, that fewer people will die if we do it this way? Well, it’s legal then, he claims.